35Thmeeting of the Board of Directors

35thMeeting of the Board of Directors

Thursday, 4th June 2009

3.30pm, Boardroom, Pinewood House

Board of Directors

Dave MellishChair

Archie HerronNon Executive Director

Anne TaylorNon-Executive Director

Bayo EmanuelNon-Executive Director

Donald Kirkham Non Executive Director

Paul WardNon Executive Director

Sally JacobsonNon Executive Director

Stephen FirnChief Executive

Richard Page Director of Finance

Peter JarrettMedical Director

Helen SmithDeputy Chief Executive and Director of Service Delivery

Simon HartDirector of HR and Organisational Development

Wilf Bardsley Director of Nursing and Governance

Directors

Keith Miller Director of Psychological Therapies

John EnserDirector of Bexley Mental Health and Forensic Services

Iain DimondDirector of Bromley Mental Health Services

Trevor EldridgeDirector of Greenwich Mental Health Services

Stephen WhitmoreDirector of Child & Adolescent Mental Health Services and Adult Learning Disability Services

In attendance

Tracy LongleyProject Manager

Susan OwenRisk Manager

Item /

Action

1 /

Apologies

Rachel Evans, Director of Estates and Facilities
Ann Rozier, Trust Secretary and Head of Governance / Noted
2 / Minutes of Board of Directors’ meeting and awayday held on 7th May 2009
Agreed as an accurate record. / Agreed
3 / Matters Arising from the Minutes of the 7th May 2009
New quality regulations
The Board considered if Quality Accounts should be audited by PricewaterhouseCoopers. It was agreed that this was not necessary.
Director of Service Delivery report
Following the publication of the Bradley Report, there will be a national programme to implement the recommendations.
SUI inquiry report – NF
NF and his associate have been found guilty of the homicide of the two students. There has been significant media coverage of this and Oxleas will release a statement to say that there was nothing the Trust could have done to predict or prevent this incident.
Board of Directors awayday minutes 7th May 2009 – review of quality arrangements
A job description for the Medical Director role has been drafted and the post will be advertised internally. It is planned to hold an appointment panel on 9th July 2009. / Noted
4. / Chief Executive update
Quarter 4 report from Monitor
The quarter 4 report from Monitor was tabled. Oxleas is in the 15% of trusts who have received the following risk ratings:
Finance = 5
Governance = GREEN
Mandatory services = GREEN
National Patient Survey
This will focus on acute in-patient units. 508 questionnaires were distributed and the response rate to date is 23%. Front line staff have been asked to remind service users to complete the questionnaire in order to maximise the response rate. The results of the survey are a key element of measuring the Trust’s performance. The survey closes on 19th June 2009 and initial headlines should be available in mid-July.
Incident reporting
There is concern that the reporting of low level incidents is decreasing. A report published by the National Patient Safety Agency (NPSA) indicates that Oxleas is 53rd out of 66 mental health trusts. SF has spoken to the Chief Executive of the NPSA and of the 24 level 4 and 5 incidents only six met their criteria for a SUI. An action plan to address under reporting of level 1 to 3 incidents has been developed. WB was asked to bring this to the next meeting of the Board of Directors.
RiO version 5
The Trust was due to go live with version 5 in July 2009, but due to functionality problems, this has been postponed. Costs will be released and staff supporting the project will be re-allocated. The Trust will continue to work with BT and Connecting for Health to agree a new date once we have assurances about the functionality and performance of version 5.
Hygiene Code
Meridian ISS are not fulfilling their obligations in relation to cleaning standards and repairs at Oxleas House. A letter has been drafted asking for robust assurances that the standards will be met, otherwise payment will be withheld. The Board agreed with the recommendation to issue this letter. / Noted
WB
SF
5. / Annual Plan 2009-10
The Annual Plan was signed off at the last meeting and has been submitted to Monitor. HS thanked Sophie Donnellan for leading the production of the Plan. / Noted
6. / Community Health Services
NHS London Perspective
SF gave an overview of the challenges facing London. Key points to note from NHS London are:
Ruth Carnell, the Chief Executive of NHS London has stated unequivocally that no PCTs will be providing primary or community health from 1st April 2010. By October 2009, PCTs need to provide assurance that this will happen.
A 20% productivity gain must be achieved over two years
There is an expectation that there should be 150 polyclinics in London by 2012. There will be no new NHS capital to build these.
Bexley
UniversalChildren’s Services will be transferring to Oxleas alongside adult services. SF is meeting with the clinical director to discuss the model of care. Visits to community sites have indicated that there is a range in the quality of the estate. There are some serious governance risks which will need to be mitigated to bring community services in line with Trust standards. The Board noted that transfer ofBarking and Dagenham community health services werereferred to Competition Panel, as part of approval process.
Bromley
The Trust must submit an Outline Business Case by 11thJune 2009. PricewaterhouseCoopers are acting as external consultants. The PCT Board will make a decision on 25th June 2009.
Lewisham
The PCT have requested that bidders submit a full business case by 9th July 2009 for presentation to stakeholders on 14th July 2009. UniversityHospital Lewisham is depending on acquiring community provider services to ensure that it has a viable future. This is supported by the local authority. It was agreedby the Board that Oxleas should withdraw from the bidding process because of concerns about capacity and strategic fit. SF will write to the PCT to thank them for the opportunity and offer our assistance at a later date if required.
The period up to April 2010 will be an intensive time and the Board discussed if additional project management resources will be required to oversee the change management process. Capacity will be reviewed in July when a decision on the future of Bromley community services has been made. There is already pressure on existing services, and the Trust should not lose sight of day-to-day business. / Noted
Agreed
SF
7. / Director of Service Delivery Report
Greenwich EIS investigation
Five SUIs have been reported from Greenwich EIS; one death due to an overdose, one death due to an accidental overdose and three serious self-harm incidents. All five incidents will be investigated.
Review of deaths due to physical health causes
There have been three deaths due to physical health causes reported from Bromley in-patient units in the past few weeks. A review is being undertaken by Stacy Washington. The outcome will be reported to the Board of Directors.
AA inquiry
The inquiry panel for the investigation into the homicide committed by AA is making links with the Somali community, as they have expressed reservations about how his care and treatment was managed. HS and PJ have arranged to meet with the family of AA.
Change programmes
Three change programmes are in place; one in Bexley adult mental health, one in ALD services and one Bromley.
Update of Service Development Strategy
The Service Development Strategy (SDS) was originally developed as a three year plan, and this is now coming to an end. The Annual Plan uses the same approach. The September awayday will be used to discuss our long term approach. / HS
8. / Annual Report 2008/09
The Annual Report has been drafted in line with Monitor requirements and has been approved by PricewaterhouseCoopers. This will be submitted on Monday 8th June and will be laid before Parliament in July. The Board of Directors approved the signatories of the report / Approved
9. / Key Performance Indicators exception report April 2009
Annual Plan targets
The target relating to carers being offered and receiving carers assessments has been adjusted to a 50% increase on the 2008/09 baseline of 284.
Bed usage
Greenwich services have had a higher number of sleepovers in April; this is being analysed to understand the source of the demand. The position is improving, but the May figures may also be higher than average. Gatekeeping processes at Assessment and Shared Care (ASC) services are being monitored to ensure that admissions are avoided where possible.
Carers
48% of carers have a care plan. Whilst the numbers are small, this indicates an upward trend. / Noted
10. / Finance report
April accounts
Income is above target as all the Bracton beds are full; this is due to a number of new referrals. There are under-spends in both pay and non-pay expenditure. UEA/ cost per casewas overspent – the budget has been reduced in 09/10 with more investment in home treatment/crisis resolution.
PCT contracts
These will be signed this week
Final accounts 2008/09
RP gave a summary of the changes following review by PricewaterhouseCoopers. The overall operating expenses reduced by £40,000 to give a revised retained deficit of £324,000. This was caused by an increase in EBITA of £841,000 due to revised cut off charges and an increase in impairment of £801,000. This was caused by the reduction in some asset valuations following a revaluation. There was also a transfer of £425,000 from I&E reserve to revaluation reserve due to the prior year adjustments arising from the previous year revaluation.
The Board agreed the following recommendations:

The approval of the accounts for the year ended 31st March 2009
The authorisation of the Chief Executive to sign the accounts
The authorisation of the Chief Executive and Chairman to sign the letter of representation
That the Board agrees that the Audit Committee may authorise amendments to the accounts

/ Noted
Approved
11. / Estates programme
The programme has been modified to fit within an envelope of £3M. There are five projects where total expenditure will exceed £100K so approval to proceed is required from the Board. These projects focus on work required to ensure compliance with the Hygiene Code and to implement change programmes. Competitive tenders for these projects are in progress.
The Bracton security developments will be included in the 2010/11 and 2011/12 programmes.
The Estates Programme was approved by the Board. / Approved
12. / Workforce report
Sickness absence is reducing which indicates a positive trend. As a result of the bulk recruitment programmes, 80 offers of employment have been made. It can take two to three months for reference and CRB checks to be completed and as there are now stricter governance requirements, posts cannot be taken up until these have been satisfactorily received. SH was asked to investigate if the CRB are able to fast track these. / Noted
SH
13. / Supervision policy
The Policy has been launched and a survey on staff experience of supervision has been undertaken. The results of these are generally positive but there are concerns that some unqualified staff are not receiving regular supervision and are not satisfied with the quality of supervision. Supervision will continue to be monitored by the Clinical Effectiveness Group. Training will be provided by KingsCollege. / Noted
14. / NHS Constitution
This was published in January 2009 as part of the Darzi review and makes a number of commitments and pledges. This has been well-received by the User and Carer Council (UCC) and a governor member of the UCC will be involved in the second stage review of complaints.
The NHS Staff Satisfaction Survey was measured against the staff pledges in the Constitution. Areas of concern to be addressed are
provision and recording of PDRs
staff safety and incident reporting
local issues to be addressed as part of directorate workforce plans
A paper on the NHS Constitution will be presented to the Council of Governors / Noted
WB / SH
15. / Governance report
SUIs
Eight SUIs have been reported up to the end of April 2009 and these have all been recorded at level 4. These consist of six unexpected deaths, one fall and one serious self-harm. The three outstanding reports from last year are being followed up. There were 42 SUIs in 2007/08 compared to 62 in 2008/09.
Incident reporting
There are concerns about the under reporting of low level incidents and the Trust is working with the NPSA to implement the action plan for this.
Infection control
There has been one incidence of MRSA skin colonisation and 3 incidents of Norovirus. WB is visiting wards to check compliance with the Hygiene Code
Safeguarding children
Sixteen referrals have been made to date. Feedback on whether they meet the criteria for multi-agency review has not yet been received. Training uptake is being monitored.
Mental Health Act
Data quality is improving. The figures are based on an audit of RiO so the Board was asked to note that the figures may not be accurate as some records may be in the paper notes and not on RiO. There is a low level of compliance for short term detentions, but overall compliance is good.
Complaints
Eleven complaints were received in April, mostly from adult services. Attitude of staff remains the most frequently raised issue in complaints. / Noted
16. / Governance Board report
The Ligature Risk Management Policy has been revised in light of the findings of the inquiry into the death of VD on Shepherdleas Ward. On recommendation of the Older Persons Strategy Group (OOPS), it has been agreed that some ligature free en-suite rooms will be available in older adult wards for high risk users.
The Governance Board will review the cost of replacing standard WC flush handles with the anti-ligature type.
17. / GreenwichSerious Case Review – Oxleas Independent Management Review (IMR)
This case relates to TL, who sustained a serious head injury at two months old. TLs mother was in contact with Oxleas services between January 2008 and October 2008. She did not meet the criteria for referral to the Day Treatment Team, so was seen by the Assessment and Shared Care Team. The focus was on meeting her mental health needs, rather than the pregnancy and other agencies involved in her care and treatment were working in isolation. The review highlights actions around:
Communication between agencies
Recognition of per-natal mental health needs
Recording of the decision making process
The Local Safeguarding Children Board (LSCB) overview report rates the Oxleas IMR as “good” and this will be submitted to Ofsted within the next few days.
An action plan will be submitted to the LSCB and this will monitored by the Trust. / Noted
18. / Council of Governors
The Council of Governors has not met since the last meeting of the Board of Directors. A new vice-chair has been appointed. DM has interviewed all Governors and has received positive feedback and will prepare an overview paper on how to improve focus / Noted
19. / Any other business
None raised
Next meeting
36thMeeting of the Board of Directors
on 2nd July 2009
Boardroom, Pinewood House

I confirm that the minutes of the Board of Directors meeting of 4th June 2009are a true record

Signed:Date: